The BMA recently reported that the average person now sees their GP six times a year, which is double the rate of just 10 years ago. This means that in our Leyburn practice of 5,950 patients an extra 17,850 appointments are required each year when compared to 10 years ago. That means an extra four hours of appointments per day. At Harewood Medical Practice in Catterick Garrison where we have 7,480 patients an extra 22,440 appointments are required each year (an extra five hours per day). We have tried to manage this by increasing the nurse led chronic disease clinics that we hold and by introducing telephone consultations. At Harewood we have also introduced the Nurse Practitioner led minor ailments and minor injuries service. Nevertheless your GP now works an average 12 hour day to keep on top of appointment demand and the background and administration work that goes with that.
Face to face appointments are the most obvious form of contact between a patient and their doctor or nurse. Often a 10 minute consultation with just two problems can generate up to two hours of further work, for example:
- Blood tests are taken, recorded, processed and sent off;
- Results are returned, checked and recorded and decisions made as to what to do next;
- A telephone call is made to you to discuss any actions arising from your test and possibly another appointment is booked;
- A referral to a hospital specialist may be required (the letter has to be dictated, details entered on the electronic referrals system and sent off);
- Any hospital appointment has to be followed up sometimes with multiple outcomes.
This example is typical of our daily work and creates a significant hidden workload which we have to deal with. Many cases are not this simple and the complexity of problems that many people have is increasing significantly. As people live longer they develop multiple conditions, not just physical but also psychological problems.
At the same time that workload has increased, average funding for general practice has decreased in real terms by between 15% and 20% over the last 10 years. To help to try to deal with the increase in demand within our funding limits we have introduced telephone triage which allows GPs to prioritise calls for appointments within two working days. Whilst that has been effective it now means that by 10:30 in the morning the list of telephone triage calls can easily reach 45 or more at Harewood and 35 or more at Leyburn. General telephone calls to the Practices have also increased dramatically and recently we received a total of 519 telephone calls in just one day at Harewood alone!
We know that all of this can be frustrating for you but please understand that our excellent Reception and Admin staff are doing their best to deal with overwhelming demand. Please consider the following points:
- Do you really need to see a GP today?
- Would a telephone consultation be adequate and does it need to be today or could it be in three or four days’ time?
- Is the need to be seen or spoken to based on medical grounds or convenience?
If you want a home visit please request this as early in the day as possible and the doctor will contact you to discuss its urgency. Bear in mind that a single home visit can take between 30 minutes and one hour to complete including travel time.
One aspect of our growing workload is the increase in medication that we prescribe. At Leyburn we issue around 1,500 prescriptions per week and at Harewood we issue around 1,200 prescriptions per week. Each prescription has to be checked an signed off by a doctor or a nurse prescriber and the management of prescription requests takes a significant amount of time for all members of the practice teams, every day. Please allow two working days from ordering your prescription until it is available and please note too that problems in the national supply chain can mean that some medication is not immediately available from our or your pharmacist’s suppliers.
Finally, please remember that we are not an emergency service. If your problem is an emergency you should call 999 without delay – in an emergency any delay could be life threatening. For less urgent problems, NHS 111 may be able to help, and please don’t forget the very valuable service that your local pharmacy can provide in terms of advice about coughs, colds and other minor ailments.
Thank you for taking the time to read this posting. We understand the anxiety caused by ill health and we appreciate your support and understanding in helping us to make the best use of our limited resources towards meeting the needs of our communities.
Dr J Brown; Dr D Ashcroft; Dr S Wild; Dr B Laybourne; Dr D Owen; Mr S Brown
Partners at Leyburn Medical Practice and Harewood Medical Practice.